HAEMATOLOGY MODULE: LYMPHOMA Adult Medical-Surgical Nursing

Lymphoma: Description A malignant neoplasm originating in the bone marrow and lymphatic system Involves the lymph nodes or other lymphoid organs as the spleen Characterised by proliferation of lymphocytes

Lymphoma: Classification Hodgkins Lymphoma Non - Hodgkins Lymphoma

Lymphoma: Aetiology Oncoviruses: Increased risk with: Immune deficiency (HIV) Immunosuppression Associated with auto - immune disorders Hodgkins: exposure to Epstein-Barr virus Occupational pesticides, dyes, benzene Genetic predisposition Aetiology unknown

Hodgkins Lymphoma

Hodgkins Lymphoma: Description 15% of adult lymphomas Age group most affected: or >50 years Affects males twice as much as females Proliferation of giant multi-nucleated cells in the lymph nodes: Reed-Sternberg cells

Hodgkins Lymphoma: Pathophysiology Hyperplasia of monocytes and macrophages (lymphoid stem cell) Reed-Sternberg cells originate in a single lymph node Spread via lymphatics to adjacent lymph nodes then to lungs, liver, spleen, CNS If originates above diaphragm confined more to nodes If below diaphragm ↑ spread to liver

Hodgkins: Clinical Manifestations Presence of non-tender hard swollen lymph node or nodes: cervical (most often first), axillary, inguinal Fever, fatigue, weakness, weight loss Tachycardia, chills, night sweats (worse prognosis) Cough, dyspnoea, dysphagia, stridor Hepatomegaly Splenomegaly

Hodgkins Lymphoma: Complications Anaemia: ↓ RBC production (pallor/ fatigue) ↑ RBC destruction (pruritis/ jaundice) Pressure signs from advancing tumour: spinal cord compression (paralysis) renal compression (urinary retention) bowel compression (constipation)

Hodgkins Lymphoma: Diagnosis Biopsy and histology of a lymph node (often cervical): Shows proliferation of giant multi-nucleated Reed- Sternberg cells Staging of disease progression to determine management

Hodgkins Lymphoma: Staging Stage 1: a single node or extra-nodal site Stage 2: two or more nodes or sites on the same side of the diaphragm Stage 3: involvement on both sides of diaphragm Stage 4: diffused throughout the body

Hodgkins Lymphoma: Management Treatment is according to the staging Treatment aims at CURE

Hodgkins Lymphoma: Management Stage 1 and 2: *Radiotherapy to the affected areas 4 – 6 weeks (sometimes with chemotherapy if thought resistant) Stage 3 and 4: Chemotherapy (and possibly radiotherapy) (poorer prognosis)

Non-Hodgkins Lymphoma

A malignant disorder of the lymphocytes: Mainly the B-cells Spreads via the blood circulation (Hodgkins spreads via lymphatics) Typically not diagnosed early: May be already stage 3 or 4 at diagnosis Early metastases to CNS

Non-Hodgkins: Clinical Manifestations Swollen lymph glands A mass in mediastinum or abdomen Pressure symptoms: Chest tightness, spinal cord compression, intra- abdominal pressure Fatigue and weakness Pyrexia, night sweats Weight loss: >10% body weight

Non-Hodgkins Lymphoma: Diagnosis Lymph node biopsy: malignant proliferation of B- cell, T-cell, non-B/ non-T Bone marrow biopsy Difficult to distinguish from ALL (but ALL bone marrow has >25% blast cells) Lymphangiography: dye traces lymphatics and remains 1 year (can monitor changes) Xray, CT scan, MRI to detect metastases

Non-Hodgkins Lymphoma:Management Systemic chemotherapy (as well as radiation to affected lymph nodes): Induction phase → Remission Sanctuary phase: (intra-thecal chemotherapy as may have spread to CNS) Maintenance therapy for 2 years

Non-Hodgkins Lymphoma: Prognosis Poorer prognosis than Hodgkins Lymphoma as often detected late

Lymphoma: Nursing Considerations Care of patient undergoing chemotherapy Care of patient undergoing radiotherapy Monitoring of blood cell count (CBC) Patient education in relation to lowered immunity Patient and family emotional and psychological support Education for control of symptoms